Classifying patients with invasive fungal disease: towards a unified case definition?

Journal: The Journal of antimicrobial chemotherapy
Published Date: Jul 24, 2025

Abstract

Management of invasive fungal disease (IFD) is increasingly challenging due to recognition of novel at-risk groups, emergence of new fungal pathogens and antifungal drug resistance. Together with the availability of new diagnostic tests and treatment modalities, robust and broadly applicable IFD case definitions are critical to support research. However, the ability to classify IFDs with the current definitions has decreased, prompting the development of new case definitions. Furthermore, current case definitions rely on a single positive test as mycological evidence, while not considering discordant evidence. We propose to explore the development of a machine learning (ML)-based IFD classification model, which uses algorithms to automatically 'learn' from observed data to consistently and accurately classify IFDs. Although developing and validating an ML-based IFD classification model is a significant undertaking, such an endeavour should be considered a worthwhile investment by the mycology community to standardize and reduce the ambiguity in the diagnosis of non-proven IFD.

Authors

  • Mehmet Ergün
    Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Roger J M Brüggemann
    Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Alexandre Alanio
    Mycology-Parasitology Department, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.
  • Robbert G Bentvelsen
    Microvida Laboratory for Microbiology, Amphia Hospital, Breda, The Netherlands.
  • Karin van Dijk
    Department of Medical Microbiology and Infection Control, Amsterdam Infection & Immunity Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
  • Meltem Ergün
    Faculty of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands.
  • Katrien Lagrou
    Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
  • Jeroen A Schouten
    Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Joost Wauters
    Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
  • P Lewis White
    Public Health Wales Mycology Reference Laboratory and Cardiff University Centre for Trials Research, University Hospital of Wales, Heath Park, Cardiff, UK.
  • Paul E Verweij
    Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, The Netherlands.

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